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Four Steps to Making Safe Gluten-Free Products
Jefferson Adams posted an article in Additional Concerns
Celiac.com 06/16/2023 - The gluten-free market has seen significant growth in recent years. With its continued rapid expansion, it is crucial for food manufacturers to understand the importance of producing gluten-free products safely. Because gluten-free diets are often a medical necessity, that means manufacturers need to adhere to strict processes throughout the entire production and packaging phases. To comply with the FDA's requirement that gluten-free foods contain less than 20 parts per million (ppm) of gluten, manufacturers need to ensure that their products meet official threshold. They also need to avoid intentionally adding any gluten-containing ingredients during production. Recent regulations on fermented and hydrolyzed products further emphasize the need for careful consideration of basic ingredients. Even inherently gluten-free ingredients like oats require attention due to potential cross-contact during growing seasons. Cheeses can also pose risks, as the cultures and enzymes used in their production may contain gluten-containing components. To minimize the risk of cross-contact, manufacturers can follow these four steps: Step 1: Perform a risk assessment Conduct a comprehensive evaluation of the materials used in your facility, assess your production layout, and determine if you have the necessary resources for gluten-free production. Consider segregating the production of gluten-free foods into dedicated areas or scheduling gluten-free manufacturing separately to reduce cross-contact risks. Step 2: Analyze your factory environment Evaluate your factory environment and production lines to see if you need a dedicated facility, or if you can manage with precautions such as dividers or curtains, to prevent cross-contact between gluten-free and gluten-containing products. Step 3: Clean your equipment Regardless of facility type, thorough equipment cleaning is essential to eliminate potential cross-contact. Adapt cleaning protocols to remove gluten, just as you would for other allergens. Pay special attention to hard-to-reach areas, and materials that may retain gluten particles. Step 4: Verify equipment through testing After cleaning, verify that no detectable gluten remains on the equipment. Use specific gluten test kits or protein swabs to check for residue. Avoid ATP swab kits as they are less sensitive to gluten proteins. Train staff to perform gluten-free verification tests, interpret results, and take appropriate actions if positive. Proficiency testing programs can aid in training and verification. With the demand for gluten-free products projected to rise, it is crucial for manufacturers to analyze risks, assess production environments, take necessary precautions, and ensure thorough cleaning and testing of equipment. By following these steps, companies can produce high-quality, safe gluten-free food for consumers adhering to a gluten-free diet due to medical necessity or personal choice. Read more at manufacturing.net -
Celiac.com 02/08/2007 - While celiac disease can affect anyone, it is more rare in Africans and Asians, and occurs most frequently in whites of Northern European ancestry, and in people with autoimmune disorders, such as: Autoimmune thyroid disease Lupus erythematosus Microscopic colitis Rheumatoid arthritis Type 1 diabetes Also, celiac disease and the tendency to get celiac disease runs in families. If one member of a family has celiac disease, the odds are that about one in ten of their first-degree relatives will also have it. People may harbor this tendency for years or even decades without showing signs or getting sick. Then, some kind of severe stress, like childbirth, infection, physical injury, or surgery can "activate" celiac disease. While the precise mechanism of this activation, and of the intestinal damage is unclear, removal of gluten from the diet usually brings about quick relief of symptoms and promotes intestinal healing in most patients.
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The Ten Risk Factors Most Associated with Celiac Disease
Jefferson Adams posted an article in Celiac Disease Basics
Celiac.com 08/16/2019 - A recent study looked at nine possible factors in children that might contribute to the development of celiac disease later in life. The study found a connection between skim milk consumption, and vitamin D drop use for more than 3 months, and later development of celiac disease. It also found evidence to support earlier data that early life exposure to antibiotics and early life infection, especially ear infection, are also associated with the development of celiac disease in children. Read more in Clinical and Experimental Gastroenterology This study and several others point to the importance of the following risk factors in the development of celiac disease. Other studies have found factors that may contribute to celiac disease. The Ten Risk Factors Most Associated with Celiac Disease Include: Genetic Factors Genetic factors play a role in celiac disease. Having a family member with celiac disease or dermatitis herpetiformis increases the chances of developing celiac disease. The risk of developing celiac disease is also increased by certain variants of the HLA-DQA1 and HLA-DQB1 genes. These genes provide instructions for making proteins that play a critical role in the immune system. A recent study shows high celiac disease rates among first-degree family relatives. Associated Diseases Having associated autoimmune or other diseases increases the likelihood of developing celiac disease. Associated diseases include: Autoimmune thyroid disease Dermatitis herpetiformis Lupus erythematosus Microscopic colitis (lymphocytic or collagenous colitis) Rheumatoid arthritis Type 1 diabetes Down syndrome or Turner syndrome Addison's disease Being Female Being female is a risk factor for celiac disease? It's true. Women get celiac disease at rates up to twice as high as men. The exact reasons for this are unknown, but many researchers are focused on the role of female immune response, and how it differs from that of men. Antibiotics Courses of antibiotics before 2 years old are associated with higher celiac disease rates. Ear Infection Incidence of ear infection before 2 years old are associated with higher celiac disease rates. The ORs for the raw categorical variables on ear infection increase with the number of such infections. In addition, the scaled ear infection exposure variable is associated with a subsequent diagnosis of celiac disease. Other studies have also shown a connection between ear infections and later celiac disease. Viral Infection Several studies have shown that exposure to certain viruses is associated with higher rates of celiac disease later on. Implicated viruses include enterovirus and reovirus. Vitamin D Drop Exposure in Infancy Some recent evidence points to the role of oral vitamin D exposure in later celiac development. While the OR on only one of the vitamin D drop categorical variables is statistically significant (Table 2), these variables do suggest a pattern. Specifically, the data suggests that infants who receive oral vitamin D drops for longer than 3 months are at increased risk of subsequently developing celiac disease. Skim Milk Recent data suggests that consumption of skim milk as the primary form of liquid cow’s milk between 2-3 years old is associated with a subsequent diagnosis of celiac disease. In general, kids who drank skim or low-fat milk had more celiac disease, and more diarrhea. Age at First Gluten Consumption A 2015 study by Carin Andren Aronsson, from the department of clinical sciences at Lund University in Sweden, and colleagues, shows that children who eat more foods with gluten before they're 2 years old have a greater risk of developing celiac disease if they carry a genetic risk factor for the condition. It's important to note, however, that while the study found an association between eating more gluten early in life and celiac disease, it wasn't designed to prove a cause-and-effect relationship. Amount of Gluten Consumed The results of a recent study showed that every daily gram increase in gluten intake in 1-year olds increases the risk of developing celiac disease autoimmunity by 5%.- 9 comments
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03/23/2020 - A team of researchers recently set out to determine the incidence of self‐reported non‐celiac wheat sensitivity (SR‐NCWS) and factors associated with its onset and resolution; to describe the prevalence of factors associated with gluten avoidance. The research team included Michael DE Potter Michael P Jones Marjorie M Walker Natasha A Koloski Simon Keely Gerald Holtmann and Nicholas J Talley AC. They are variously affiliated with the University of Newcastle, Newcastle, NSW; John Hunter Hospital, Newcastle, NSW; Macquarie University, Sydney, NSW; and the University of Queensland, Brisbane, QLD, and Princess Alexandra Hospital in Brisbane, QLD. The team designed a longitudinal study that analyzes responses to self‐administered validated questionnaires in the form of Digestive Health and Well Being surveys from 2015 and 2018. They randomly chose a sample of the 2015 adult population from the electoral rolls for the Newcastle and Gosford regions of New South Wales. Their main outcome measures included rates of SR‐NCWS; rates of gluten avoidance and reasons for gluten avoidance; incidence and resolution of SR‐NCWS, including demographic and medical factors. Just over 60% of the 2,185 eligible people finished the 2018 survey. The team found that rates of SR‐NCWS were just about 14% in 2015 and 2018. Between 2015 and 2018, 69 of 1,301 respondents reported a new case of incident SR‐NCWS, a rate just under two percent per year. Incident SR‐NCWS was strongly associated with functional dyspepsia, and negatively associated with being male or older. That is, incident SR-NCWS sufferers tend to be female and younger. About one in four respondents reported gluten avoidance in 2018. More than 8 out of 10 respondents reported avoiding gluten only partially, while about one in five avoid gluten totally. More than half of those avoiding gluten cited general health as the reason. All 13 participants with celiac disease, 56 of 138 with irritable bowel syndrome, and 69 of 237 with functional dyspepsia followed a gluten-free diet. Rates of SR‐NCWS were similar for both 2015 and 2018. Functional gastrointestinal disorders were associated with 2015 baseline and 2018 incident SR‐NCWS. Far more people avoid gluten than have celiac disease or SR‐NCWS. People without celiac disease or SR‐NCWS who eat gluten-free are mainly looking for healthier food, and to reduce abdominal discomfort. Read more in the Medical Journal of Australia -
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Celiac.com 08/01/2019 - Rates of celiac disease have climbed steeply in recent decades in some developed countries. However, there really isn't much in the current medical literature to clearly explain the increase. Researchers Seth Scott Bittker and Kathleen Roberta Bell recently set out to determine whether nine variables are associated with the development of celiac disease in children. They are variously affiliated with the Interdisciplinary Center for Innovative Theory and Empirics (INCITE), Columbia University, New York, New York, US; and the Ontario College of Teachers, Toronto, Ontario, Canada. The team looked at the following variables: "incidence of ear infection before 2 years old, courses of antibiotics before 2 years old, duration of breastfeeding, vitamin D drop exposure in infancy, vitamin D supplement exposure between 2–3 years old, age at gluten introduction into the diet, fat content of cow’s milk consumed between 2–3 years old, quantity of cow’s milk consumed between 2–3 years old, and type of water consumed at 2 years old." To gather their data, the team used an internet survey to quiz parents living in the US with at least one biological child between 3 and 12 years old. To recruit participants, the team used social media, websites, electronic newsletters, and advertisements. The team ended up with a total of 332 responses for children with celiac disease, and 241 responses from the non-celiac control group. The team's data showed that skim liquid cow’s milk consumed between 2–3 years old, vitamin D drops used for longer than 3 months, early doses of antibiotics, and early ear infection are all associated with later development of celiac disease in children. This study found a connection between skim milk consumption, and vitamin D drop use for more than 3 months, and later development of celiac disease. It also found evidence to support earlier data that early life exposure to antibiotics and early life infection, especially ear infection, are also associated with the development of celiac disease in children. Read more in Clinical and Experimental Gastroenterology -
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Celiac.com 12/12/2017 - Does a gluten-free diet have any effect on cardiovascular risk in people with celiac disease? Does it effect people without celiac disease? So far, both questions have remained unanswered. Recently, a team of researchers set out to conduct a systematic review to shed some light on the matter. The team was led by Michael D.E. Potter, MBBS (Hons), from the University of New Castle, Australia. The team focused their review on the "potential of the gluten-free diet to affect modifiable cardiovascular risk factors including weight, blood pressure, cholesterol and blood sugars," and to do this they searched for "studies which measured these risk factors in individuals before and after the institution of a gluten-free diet." In all, Potter and colleagues reviewed 27 studies that evaluated the effect of a gluten-free diet, as followed for a minimum of 6 months, on cardiovascular risk factors such as BMI, waist circumference, blood pressure, fasting glycemia, hemoglobin A1c and serum lipids. Despite their efforts, they found no clear evidence that a gluten-free diet increases cardiovascular risk in celiac patients. They found no evidence that it increases heart disease risk in people without celiac disease. They really found nothing much at all. While the results varied across studies, and researchers did see changes in some cardiovascular risk factors, they say the data do not support a gluten-free diet for cardiovascular health in individuals without celiac disease. True, perhaps. But it's also true that the data neither support nor condemn a gluten-free diet in people without celiac disease. Unless and until researchers get some solid data from large groups and can make accurate, informative comparisons between those groups, it seems foolish for them to advocate or discourage a gluten-free diet in people without celiac disease. Source: Healio.com -
Celiac.com 03/03/2017 - Previous studies have shown us that men are generally less troubled living with celiac disease than are women, but most studies of men with celiac disease have been mostly quantitative, and have a bio-medical emphasis. A team of researchers recently set out to explore the social experience of young men with screening-detected celiac disease and to highlight daily life situations five years after diagnosis. The research team included Ethel Kautto, Cecilia Olsson, Anneli Ivarsson, Phil Lyon, Agneta Hörnell, and Lena Alex. They are variously affiliated with the Department of Food and Nutrition and Umeå Center for Gender Studies, Umeå University, Sweden, the Department of Food and Nutrition, Umeå University, Sweden, the Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Sweden, the School of Arts, Social Sciences and Management at Queen Margaret University, UK, and the Department of Nursing at Umeå University in Sweden. Using a large Swedish school-based celiac screening-study, the team arranged to interview seven young men, all of whom were diagnosed with celiac disease at 13 years-old. The semi-structured interviews were analyzed from a gender perspective which resulted in three themes. Those themes were of young adult men being subjected to changes, striving for normality and emphasizing commitment. Many of young men reported dissociating themselves from being seen as a person with a life-long chronic disease. The analysis also showed that the young men’s daily experiences of living with celiac disease largely depended on their use of characteristics known to be associated with masculinity: such as being self-assured, demanding, and behaving authoritatively. In food situations, where the young men had the ability to make use of such characteristics in their informal group, they experienced fewer negative aspects of the disease. If the young men did not hold a strong position in their informal group, their situation was insecure and vulnerable and this could lead to avoidance of contacts and social meal situations. So, basically, being relaxed and socially confident about eating gluten-free helps to ensure success with the diet. Source: International Journal of Celiac Disease Vol. 4, No. 4, 2016, pp 138-145. doi: 10.12691/ijcd-4-4-7 -
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Celiac.com 09/09/2016 - Celiac disease incidence has increased in recent decades. How much do sex, age at diagnosis, year of birth, month of birth and region of birth have to do with celiac disease risk? A team of researchers recently conducted a nationwide prospective cohort longitudinal study to examine the association between celiac disease diagnosis and season of birth, region of birth and year of birth. The research team included Fredinah Namatovu, Marie Lindkvist, Cecilia Olsson, Anneli Ivarsson, and Olof Sandström. They are variously affiliated with the Department of Food and Nutrition, the Department of Clinical Sciences, Pediatrics, and the Department of Public Health and Clinical Medicine, Epidemiology and Global Health at Umeå University in Umeå, Sweden. Their study included 1,912,204 children aged 0–14.9 years born in Sweden from 1991 to 2009. They found a total of 6,569 children diagnosed with biopsy-verified celiac disease from 47 pediatric departments. The team used Cox regression to examine the association between celiac disease diagnosis and season of birth, region of birth and year of birth. They found that children born during spring, summer and autumn had higher celiac disease risk, as compared with children born during winter: adjusted HR for spring 1.08 (95% CI 1.01 to 1.16), summer 1.10 (95% CI 1.03 to 1.18) and autumn 1.10 (95% CI 1.02 to 1.18). Increased celiac disease risk was highest for children born in the south, followed by central Sweden, as compared with children born in northern Sweden. The birth cohort of 1991–1996 had increased celiac disease risk if born during spring, for the 1997–2002 birth cohort the risk increased for summer and autumn births, while for the birth cohort of 2003–2009 the risk was increased if born during autumn. Both independently and together, season of birth and region of birth are associated with increased risk of developing celiac disease during the first 15 years of life. These seasonal differences in risk levels are likely due to seasonal variation in infectious disease exposure. Source: Arch Dis Child. doi:10.1136/archdischild-2015-310122 -
Celiac.com 12/02/2015 - A strict gluten-free diet remains the only effective treatment for celiac disease, but studies of gluten-free diet adherence have rarely used precise means of measuring data, which means that there really hasn't been much good data on long-term adherence to the gluten-free diet in the adult population. So, what are the factors that keep people on a gluten-free diet? This question has been on the minds of numerous celiac disease researchers. To determine the long-term adherence to the gluten-free diet and potential associated factors, a research team recently conducted a survey of adult celiac patients in a large celiac disease referral center population. The research team included J. Villafuerte-Galvez; R. R. Vanga; M. Dennis; J. Hansen; D. A. Leffler; C. P. Kelly; and R. Mukherjee. They are variously affiliated with the Celiac Center, Division of Gastroenterology, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA. Their team performed a mail survey of adults with clinically, serologically and histologically confirmed celiac disease diagnosed five or more years prior to the survey. To measure dietary adherence, the team used the previously validated Celiac Disease Adherence Test. The team then analyzed demographic, socio-economic and potentially associated factors as they relate to dietary adherence. Of 709 people surveyed, about half responded. Their responses showed an average of about 10 years on a gluten-free diet, plus or minus 6.4 years. Adequate adherence was measured by a celiac disease adherence test score under 13. Just over 75% of respondents reported adequate dietary adherence. A higher level of education was associated with adequate adherence (P = 0.002) even after controlling for household income (P = 0.0220). Perceptions of cost, effectiveness of the gluten-free diet, knowledge of the gluten-free diet and self-effectiveness at following the gluten-free diet correlated with adherence scores (P < 0.001). More than 75% of respondents reported long-term adherence to a gluten-free diet Perceived cost remains one of the main barriers to long-term adherence to a gluten-free diet. Perceptions of effectiveness of gluten-free diet as well as its knowledge, are potential areas where better information may increase dietary compliance. Source: Aliment Pharmacol Ther. 2015;42(6):753-760. -
Celiac.com 06/12/2015 - Some researchers have suspected that certain prenatal and perinatal factors might affect risk for development of celiac disease, but there is very little data. With this in mind, a team of researchers set out to determine if any prenatal and perinatal factors might affect risk for development of celiac disease in children. Their team assessed the association of fetal growth, birth weight, and mode of delivery with development of celiac disease within the Norwegian Mother and Child (MoBa) Cohort Study. The research team included Louise Emilsson, Maria Christine Magnus, and Ketil Størdal. They are variously affiliated with the Primary Care Research Unit, Vårdcentralen Värmlands Nysäter, County Council of Värmland, Sweden, the Department of Health Management and Health Economy, Institute of Health and Society, University of Oslo, Oslo, Norway, the Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway, and the Paediatric Department, Ostfold Hospital Trust, Fredrikstad, Norway. To make their determination, the team used the MoBa cohort, which contains pregnancy information on 95,200 women and data on their 114,500 children. The information was collected in Norway from 1999 through 2008; it is linked to the Norwegian Medical Birth Registry. The team used the National Patient Registry and women’s responses to MoBa questionnaires to identify women and children with celiac disease. The team calculated odds ratios (ORs) for celiac disease by using a multivariable logistic regression model, adjusting for maternal celiac disease, sex of children, and children’s age (model 1). In model 2, they adjusted for age of gluten introduction and duration of breastfeeding. The team identified 650 children with celiac disease and 107,828 controls in the MoBa database. They found no connection between birth weight or height with celiac disease, including for children who were born small for gestational age. They found no celiac disease connection based on mode of delivery (cesarean section, model 1: OR, 0.84; 95% confidence interval [CI], 0.65–1.09, and model 2: OR, 0.83; 95% CI, 0.63–1.09). They did find that maternal celiac disease, adjusted for age and sex of the children and type 1 diabetes were associated with development of celiac disease in children, whereas maternal type 2 diabetes and gestational diabetes were not. Their analysis of the Norwegian MoBa cohort shows that development of celiac disease in children is significantly associated with sex of the child, maternal celiac disease, and type 1 diabetes, but not with gestational development. Source: Clinical Gastroenterology and Hepatology. DOI: http://dx.doi.org/10.1016/j.cgh.2014.10.012
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Celiac.com 07/23/2014 - Transaminasemia develops through various pathways in patients with celiac disease. Currently, there is not much information on risk factors specifically attributable to celiac disease. A team of researchers recently set out to determine what factors contribute to hypertransaminasemia in patients with celiac disease. The research team included B. Zanini B, R. Baschè A., Ferraresi, M.G. Pigozzi, C. Ricci, F. Lanzarotto, V. Villanacci, and A. Lanzini. They analyzed data collected from consecutive patients referred from January 1997 through December 2009 to the celiac disease clinic at the Spedali Civili of Brescia, Italy. They then used serologic and biopsy analysis to assess the factors influencing hypertransaminasemia in 683 patients with celiac disease (group A), and 304 patients with functional gastrointestinal syndromes (group . Both groups were about the same average age and range. The research team detected hypertransaminasemia in 138 patients in group A (20%). Factors associated with the condition included malabsorption (odds ratio [OR], 2.22; P = .004), diarrhea (OR, 1.72; P = .005), and increasing severity of mucosal lesion (Marsh-Oberhuber class; OR, 1.46; P = .001), but not body mass index (BMI) or the blood levels of tissue-transglutaminase antibodies (tTG). The team also detected hypertransaminasemia in 22 patients from group B (7%), which they found to be associated with the World Health Organization's BMI categories (OR, 7.9; P < .001). A total of 313 patients from group A had significantly higher levels of tTG at baseline (25.2 ± 16.9 U/L aspartate aminotransferase [AST]) than a similar bunch from group B (20.6 ± 9.9 U/L AST, P < .0001). These levels were related to BMI in group B (P = .0012), but not group A. Patients eating gluten-free diets saw levels of AST decrease from 25.2 ± 16.9 U/L to 19.9 ± 6.6 U/L (P < .0001). This decrease was independent of the changes of duodenal histology and tTG and correlated with BMI (P = .0007). Meanwhile, the prevalence of hypertransaminasemia in gluten-free patients decreased from 13% to 4%. These study results show that hypertransaminasemia is more common in people with celiac disease than in patients with functional gut syndromes. Also, hypertransaminasemia is related to the severity of the duodenal lesion and malabsorption, but unrelated to BMI. By contrast, the control group, with functional gut syndromes, showed a positive correlation between the levels of AST and BMI. This relationship was restored when patients with celiac disease began to follow gluten-free diets. Source: Clin Gastroenterol Hepatol. 2014 May;12(5):804-810.e2. doi: 10.1016/j.cgh.2013.10.033. Epub 2013 Nov 7.
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Celiac.com 09/09/2011 - A team of researchers recently set out to assess the effects of milk-feeding behavior and the HLA-DQ genotype on intestinal colonization of Bacteroides species in infants with a risk of developing celiac disease. The research team included E. Sánchez, G. De Palma, A. Capilla, E. Nova, T. Pozo, G. Castillejo, V. Varea, A. Marcos, J. A. Garrote, I. Polanco, A. López, C. Ribes-Koninckx, M. D. García-Novo, C. Calvo, L. Ortigosa, F. Palau, and Y. Sanz. They are affiliated with the Ecofisiología Microbiana y Nutrición, Instituto de Agroquímica y Tecnología de Alimentos (CSIC) in Valencia, Spain. The team studied 75 full-term newborns with at least one first-degree relative who suffered from celiac disease. They classified the newborns according to milk-feeding practice (breast-fed or formula fed) and HLA-DQ genotype, which indicates high or low genetic risk. The team used PCR and denaturing gradient gel electrophoresis (DGGE) to analyze stools at 7 days, 1 month, and 4 months. They found that formula-fed infants showed greater Bacteroides species diversity than did breast-fed infants. Breast-fed infants showed a higher prevalence of Bacteroides uniformis at 1 and 4 months of age, while formula-fed infants had a higher prevalence of B. intestinalis at all sampling times, of B. caccae at 7 days and 4 months, and of B. plebeius at 4 months. Infants with low genetic risk showed greater colonization of B. ovatus, B. plebeius, and B. uniformis, while those with high genetic risk showed a greater colonization of B. vulgatus. Among breast-fed infants, those with low genetic risk had greater colonization of B. uniformis than those with high genetic risk, who showed higher rates of B. vulgatus. Among formula-fed infants, the prevalence of B. ovatus and B. plebeius was increased in those with low genetic risk, while the presence of B. vulgatus was greater in those with high genetic risk. The results indicate that both the type of milk feeding and the HLA-DQ genotype influence the types of Bacteroides that colonize in the intestinal tract, and possibly also influence risk for developing celiac disease. Source: Appl Environ Microbiol. 2011 Aug;77(15):5316-23. Epub 2011 Jun 3. -
Celiac.com 06/24/2013 - Researchers don't know much about the genetic history of celiac disease. They know especially little about the age of specific gene sequences that leave people at risk for developing celiac disease. A recent case study provides a small bit of information about that question. The information was gathered by a team of researchers looking into the case of a young, first century AD woman, found in the archaeological site of Cosa. The woman's skeleton showed clinical signs of malnutrition, such as short height, osteoporosis, dental enamel hypoplasia and cribra orbitalia, indirect sign of anemia, all strongly suggestive for celiac disease. The research team included G. Gasbarrini, O. Rickards, C. Martínez-Labarga, E. Pacciani, F. Chilleri, L. Laterza, G. Marangi, F. Scaldaferri, and A. Gasbarrini. They are affiliated with the Ricerca in Medicina Foundation NGO, Falcone and Borsellino Gallery, in Bologna, Italy. However, initial inspection of the woman's bones did not provide answers about the genetics that might confirm that these traits were, in fact, associated directly with celiac disease. To do that, the team needed to examine her human leukocyte antigen (HLA) class II polymorphism. That required extracting DNA from a bone sample and a tooth and genotyping HLA using three HLA-tagging single nucleotide polymorphisms for DQ8, DQ2.2 and DQ2.5, specifically associated to celiac disease. The results showed that the woman did in fact carry HLA DQ 2.5, the haplotype associated to the highest risk of celiac disease. This is the first time that researcher have documented the presence of a celiac-associated HLA haplotype in an archaeological specimen. The results show that the genetic markers associated with high risk of celiac disease are at least a couple of thousand years old. Source: World J Gastroenterol. 2012 Oct 7;18(37):5300-4. doi: 10.3748/wjg.v18.i37.5300.
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Celiac.com 09/15/2010 - Until the present study, no clinical research had been published regarding the relative effects of clinical and psychosocial variables on outcome in celiac disease. A team of researchers examined psychosocial factors that may influence disease activity in celiac patients, such as relationships among demographics, psychosocial factors, and disease activity with health-related quality of life (HRQOL), health care utilization, and symptoms. The research team included Spencer D. Dorn, Lincoln Hernandez, Maria T. Minaya, Carolyn B. Morris, Yuming Hu, Suzanne Lewis, Jane Leserman, Shrikant I. Bangdiwala, Peter H. R. Green and Douglas A. Drossman of the Center for Functional GI and Motility Disorders at the University of North Carolina, Chapel Hill, USA. The team enrolled 101 adult patients with celiac disease with the goal of charting any relationships among demographics, psychosocial factors, and disease activity with health-related quality of life (HRQOL), health care utilization, and symptoms. All patients were newly referred to a tertiary care center with biopsy-proven celiac disease. The team examined: (a) demographic factors and diet status; ( disease measures (Marsh score, tissue transglutaminase antibody (tTG) level, weight change and additional blood studies); and © Psychosocial status (psychological distress, life stress, abuse history, and coping). They then conducted multivariate analyses to predict HRQOL, daily function, self-reported health, number of physician visits, and GI symptoms, such as pain and diarrhea. They found that patients with psychological distress and poor coping skills suffered from impaired HRQOL and daily function. Patients who reported poorer health generally showed poorer coping, longer symptom duration, lower education, and greater weight loss. Patients with poorer coping, abnormal tTG levels, and milder Marsh classification generally had more physician visits. Patients with higher psychological distress and greater weight loss also showed higher pain scores. Patients with greater psychological distress and poorer coping also showed higher rates of diarrhea. Their results show that among patients at celiac disease referral centers, psychosocial factors have a greater impact on health status and GI symptoms than does disease activity. Such factors should be considered as part of the patient's treatment and prognosis. Source: Dig Dis Sci. 2010 Jul 30. DOI: 10.1007/s10620-010-1342-y -
Celiac.com 05/06/2008 - In the majority of people with celiac disease,strict adherence to a gluten-free diet can result in a quality of lifethat is on par with non-celiacs. Still a small percentage of celiacsseem to suffer from persistent gastrological discomfort in the form ofirritable bowel or irritable-bowel-like symptoms. Very few studies havebeen done on persistent gastrological problems in adults with celiacdisease. Those that have been done rely upon univariate statisticalanalysis in clinical samples at the secondary or tertiary care leveland fail to assess the potential influence of non-celiac diseasespecific factors, which are considered to be a risk factor of irritablebowel syndrome (IBS), such as mental disorders, or gender. Ateam of researchers made up of doctors Winfried Hauser, Frauke Musial,Wolfgang Caspary, Jurgen Stein, and Andreas Stallmach set out todetermine rates of irritable bowel syndrome, irritable bowelsyndrome-related symptoms, and consecutive health care-seeking behaviorand their influence upon health-related quality of life (HRQL) and anyconceivable bio-psychosocial factors influencing adult patients withceliac disease. The research team made a medical and socio-demographicsurvey of 1000 adult celiac patients from the German Celiac Society bypost. The medical portion of the survey included bowel history. Theteam also had patients fill out a Short Form Health Survey (SFHS),along with the Hospital Anxiety and Depression Scale. 516 ofthe questionnaires came back completed. Respondents were similar ingender ratio and median age from the whole membership directory of theGerman Celiac Society, a group of more than 18,000 people who reportedsuffering from celiac disease at the age of 18. Of these, 213 (41.3%)had a diagnosis of celiac disease that was made by a duodenal biopsy,37 (7.2%) by serological tests (celiac disease-specific antibodies), 34(6.6%) using stool tests for trans-glutaminase antibodies, and 232(45.0%) using intestinal biopsy and serological tests. A totalof 446 patients indicated that they had biopsy-proven celiac disease. Of these 446patients, 18 were excluded because they indicated adherence to agluten-free diet for less than 1 year. Sixteen patients were tossed outbecause they reported a major non-adherence to the gluten-free diet. Thus,the study group was confined to 412 patients with self-reportedbiopsy-proven celiac disease who were on a strict gluten-free diet for at least one year. The survey showed that out of these 412 patients that met the criteria, 96 patients, or just over 23% metmodified Rome I criteria for Irritable Bowel Syndrome. Of those 96patients, 76 patients, or nearly 80%, made an effort to get help, bothmedical and non-medical, as a result of the bowel symptoms (we’ll callthe patients who sought help "irritable bowel syndrome patients"). Irritable bowel syndrome-like symptoms were shown to drive SFHS scores sharply downward. Mentalhealth disorders, being female, falling off the gluten-free dietall contributed to a greater likelihood of irritable bowel syndrome symptoms. Theresults of the study seem strengthen the bio-psychosocial model of irritable bowel syndrome, in which biological and psychological factorsare understood to affect the clinical manifestation of celiac disease.Under this model, irritable bowel syndrome-like symptoms in adults withceliac disease are understood through a combination of clinical andsocio-psychological mechanisms. This model leads doctors to anunderstanding of celiac disease and other gastro-intestinal ailmentsthat goes beyond simple biological or psychological factors alone, andlooks at factors like adverse life events, stress, and hypochondriasisamong others. Limited studies indicate that gender differencesin visceral perception, cardio-autonomic responses, gastrointestinalmotility, and brain activation patterns to visceral stimuli are afactor in irritable bowel syndrome. Gender differences in psychosocialfactors have not been fully studied. The results of this studyalso support the need for further investigation to determine exactly whatfactors contribute to the bio-psychosocial model of what is called’celiac irritable bowel syndrome.’ Future psycho-physiologicalstudies in patients with celiac disease and irritable bowel syndromeshould look to determine if psychological discomfort can prolongmucosal inflammation, reduce visceral pain thresholds, or disturb gutmotility. In the event that the right psychotherapeutictreatment for irritable bowel syndrome-like symptoms and/or mentaldisorder serve to improve reduced HRQOL in adult patients with celiacdisease and irritable bowel syndrome-like symptoms, it might benecessary to take a second look at interventional practices. So,in a nutshell, this all means that things like mental health, gender,and other non-clinical factors might play a role in irritable bowelsyndrome-like symptoms in people with celiac disease, and that furtherstudy is needed to sort out all of the possibilities and determine ifthere might be better ways to treat celiac disease that will reduce oreliminate irritable bowel syndrome-like symptoms. Psychosomatic Medicine 69:370 –376 (2007)
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Celiac.com 06/29/2010 - Properly diagnosing children with celiac disease in conditions where there may be environmental or other causes for classic celiac-associated symptoms, such as malnutrition, diarrhea, and failure to thrive, can present challenges to clinicians. A clinical team conducted an assessment of celiac disease blood screens in symptomatic 12 to 36 month-old children. The research team included Inês Cristina Modelli; Lenora Gandolfi; Rodrigo Coutinho de Almeida; Gloria Maria A. C. Araújo; Marilúcia de Almeida Picanço; and Riccardo Pratesi. They are associated with the Graduate Program in Health Sciences at the University of Brasilia School of Health Sciences, the Pediatric Department at the Brasilia University Hospital, and the Pediatric Research Center and Celiac Disease Investigation Center at the University of Brasilia School of Medicine in Brazil. The clinicians wanted to assess rates of celiac disease in a group of 12 to 36 month-old children using immunoglobulin antibodies against gliadin (IgG and IgA-AGA), against endomysium (IgA-EMA), and anti-human tissue transglutaminase (IgA-tTG) screens. For the study, the team enrolled 114 boys and 100 girls, aged 12 to 36 months, all following a gluten-containing diet. The team performed IgG and IgA-AGA, IgA-tTG and IgA-EMA blood tests for each patient. The team took biopsies from all children who showed one or more positive blood test, except those for whom IgG-AGA was the only positive result. In cases where IgG-AGA was the only positive result, the team used polymerase chain reaction (PCR) HLA genotyping to identify the celiac disease predisposing alleles. HLA genotyping also allowed the team to confirm diagnosis in children flagged as celiac by means of positive serologic testing and compatible biopsy results. The team found that 131 kids showed normal results. PCR showed the presence of celiac disease predisposing alleles in ten out of 68 children who tested positive on just the IgG-AGA test. Four kids had positive results on all four blood tests, while a fifth child showed positive results IgG and IgA-AGA and IgA-tTG, but showed negative results for IgA-EMA. All five children submitted to jejunal biopsies, which showed classic celiac lesions. Symptomatic children from 12- to 36-months old that had not been previously diagnosed with celiac disease showed celiac prevalence of 2.3%. This study shows several things. First, the data reflect the challenges of diagnosing celiac disease in areas where environmental or other causes for classic celiac-associated symptoms might interfere with proper diagnosis. The results also show the advantages of considering biopsies in cases of conflicting or incomplete blood screens in symptomatic children who may be subject to environmental and other mitigating factors. That such symptomatic children show celiac disease rates that are more than double the general population shows that clinicians attempting diagnosis under such circumstances should be both diligent and exhaustive in their efforts. As it is, symptomatic children with celiac disease are going undiagnosed. To properly diagnose such cases, clinicians should consider any environmental or other causes for classic celiac-associated symptoms that might interfere with proper diagnosis. There is no reason to assume that these results are exclusive to Brazil. There's no reason to assume these results wouldn't apply anyplace where environmental and other causes might interfere with diagnosis of celiac disease in symptomatic children, including regions of rural and urban poverty. Source: PEDIATRIC GASTROENTEROLOGY GASTROENTEROLOGIA PEDIÁTRICA vol.47 no.1 São Paulo -
Celiac.com 06/22/10 - A research team set out to examine gut diseases and prognostic factors tied to non-cirrhotic intrahepatic portal hypertension. The team included C. E. Eapen, Peter Nightingale, Stefan G. Hubscher, Peter J. Lane, Timothy Plant, Dimitris Velissaris, and Elwyn Elias. The prognosis for non-cirrhotic intrahepatic portal hypertension (NCIPH) is usually benign. Assessment of a cohort study followed-up at a tertiary referral center leads the research team to hypothesize that gut-derived prothrombotic factors may contribute to the pathogenesis and prognosis of NCIPH. The team conducted a retrospective analysis of celiac disease indicators in 34 NCIPH patients. They also looked for associated gut conditions. Survival rates for transplant-free NCIPH patients from first presentation of symptoms was 94% (SE: 4.2%) at one year, 84% (6.6%) at 5-years, and 69% (9.8%) at 10-years. Sixteen of the patients (53%) showed decompensated liver disease. Three (9%) patients suffered ulcerative colitis, while five of 31 (16%) had clinical celiac disease. Kaplan–Meier analysis showed that celiac disease patients was a predictor of lower transplant-free survival (p = 0.018) rates. Multivariable Cox regression analysis revealed that other predictors of reduced transplant-free survival included older age at first NCIPH presentation, hepatic encephalopathy, and portal vein thrombosis. Just over one-third (36%) of patients with NCIPH showed substantially higher initial serum IgA anticardiolipin antibody (CLPA), compared to 6% with Budd–Chiari syndrome (p = 0.032 using Fisher’s exact test) and no celiac disease patients without concomitant liver disease (p = 0.007). In addition to noting factors affecting prognosis, the team found that just over half (53%) of NCIPH cases resulted in liver failure. Source: Dig Dis Sci. 2010 May 25. PMID: 20499175 -
Eur J Gastroenterol Hepatol 2000;12:1195-1199. Celiac.com 01/20/2001 - Italian researchers have identified several key factors that contribute to bone loss in adults with celiac disease, including the following: Gender Malnutrition Disease Severity Physical Activity They also conclude that, contrary to current belief, age at diagnosis, sunlight exposure and smoking do not seem to be significant factors in bone mineral density. In their study, Dr. Gino Roberto Corazza (University of Pavia) and associates evaluated 39 adults with untreated celiac disease, including 18 who had symptoms and 21 who did not. The researchers used dual-energy X-ray absorptiometry to measure lumbar spine and femoral neck bone mineral density, and assessed the patients physical activity, cigarette smoking, nutritional status and exposure to sunlight. The results of the study indicate that femoral and lumbar bone mineral density was lower in patients with symptoms than patients without, and women tended to have lower mineral bone density than men. This finding, in combination with other factors were associated with reduced bone mineral density in the femoral neck, lumbar spine or both. Further, the key factors seem to be the severity of the patients symptoms and their nutritional status, both of which had significant effects on both lumbar and femoral bone mineral density. The patients levels of physical activity affected only femoral bone mineral density, and the gender of the patient affected mainly the lumbar density. This is one of the first studies of its kind, and Dr. Corazzas group stresses the need for follow-up studies to determine whether additional therapeutic measures such as moderate and on-going physical activity and a more rapid implementation of a gluten-free diet might be useful in increasing the bone mass gain in people with celiac disease. -
Celiac.com 05/08/2007 - For people with celiac disease, accurate and comprehensive information on maintaining a healthy, high-level quality of life can be difficult to find. Research is particularly sketchy with respect to factors that have a negative impact on health and quality of life for adults with celiac disease. Factors that have a negative impact on health and quality of life are often modifiable through changes in diet, or adjustments in treatment. Thus researchers are motivated to identify which celiac patient groups are at risk of being impacted in a negative way, and to determine which adjustments might bring positive results. In an effort to refine treatment approaches and improve the lives of patients with celiac disease, clinical researchers in Gastroenterology have become increasingly interested in health-related quality of life issues as primary or secondary endpoints in their studies. A recent study published online in Medscape Today suggests that, in addition to physical and mental co-morbidities, a failure to sustain a gluten-free diet and disappointment with doctor-patient communication are also important factors associated with health-related quality of life concerns in people with celiac disease. Motivated by inconsistencies in available data, a team of German researchers made up of Drs. W. Häuser, A. Stallmach, W. F. Caspary, and J. Stein, set out to evaluate the various predictors for reduced health-related quality of life in adult patients with celiac disease. Using logistic regression analysis, the researchers catalogued responses to medical and socio-demographic questionnaires by 1000 adult celiac disease patients who were members of the German Coeliac Society. The subjects responded to the following three survey questionnaires, which were administered by post: 1) the Short-Form Health Survey (SF-36); 2) the Celiac Disease Questionnaire; 3) the Hospital Anxiety and Depression Scale. The results showed that physical co-morbidities (ß = -0.41; OR = 0.66, P < 0.001) and mental disorder (ß = 0.88; OR = 2.4, P = 0.03) were associated with a reduced physical summary score of the SF-36 Scale. Mental disorder (ß = 2.5; OR = 11.9, P < 0.001), physical co-morbidities (ß = -0.26; OR = 0.77, P = 0.004) and younger age at diagnosis (ß = -0.10; OR = 0.91, P = 0.05) predicted a reduced mental summary score of the SF-36 Scale. Mental disorder (ß = 0.90; OR = 2.5, P = 0.03), non-compliance with gluten-free diet (ß = 0.44; OR = 1.6, P = 0.009), active medical co-morbidities (ß = -0.28; OR = 0.76, P = 0.007) and dissatisfaction with doctor–patient communication (ß = 0.55; OR = 1.7, P = 0.03) were associated with reduced Celiac Disease Questionnaire scores. In adult patients with celiac disease, the following factors were associated with reduced health-related quality of life: female gender, younger age at diagnosis, newly diagnosed patients, latency of diagnosis, failure to follow a gluten-free diet, anxiety and somatic and psychiatric co-morbidity. Until this study, attempts to measure health status in patients with celiac disease relied on generic health-related quality of life methods, rather than validated, disease specific instruments, and thus the relative predictive value of these variables had not been fully assessed. Aliment Pharmacol Ther. 2007;25(5):569-578.
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Are there any unique factors to be considered for children? (I've heard that the serology has a lower predictive value for children under age two, since IgA may be depressed, or with anyone who has a condition which depresses IgA.)**
Scott Adams posted an article in Frequently Asked Questions About Celiac Disease
Vijay Kumar, M.D., Research Associate Professor at the University of Buffalo and President and Director of IMMCO Diagnostics: Not really. It is not true that the serological methods have lower predictive value in children less than two years of age. In all the studies that we did, there was 100% correlation of the EMA to the disease activity irrespective of the age. Karoly Horvath, M.D., Ph.D., Associate Professor of Pediatrics; Director, Peds GI & Nutrition Laboratory; University of Maryland at Baltimore: There are age dependent changes in several blood parameters during childhood. It is well known that immunoglobulin levels depend on the age of children. E.g. the IgA class immunoglobulins reach the adult level only by 16 years of age, and the blood level of IgA immunoglobulins is only 1/5th of adult value below two years of age. A large study from Europe (Brgin-Wollf et al. Arch Dis Child 1991;66:941-947) showed that the endomysium antibody test is less specific and sensitive in children below two years of age. They found that the sensitivity of the EmA test decreased from 98% to 88% in children younger than 2 years of age. It means that 12% of their patients with celiac disease, who were younger than two years of age, did not have an increase in their endomysium antibody levels. -
AU- Khoshoo V; Bhan MK CS- Department of Pediatrics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India. JN- Indian Pediatr; 27 (6) p559-69 PY- Jun 1990 AB- The associated factors in 80 children (less than 2 yrs) with protracted diarrhea (greater than 21 days duration) and weight loss were: secondary carbohydrate intolerance (36): enteric pathogens (non typhoidal salmonella (11), enteropathogenic E. coli EPEC (6), giardia (4), and shigella (3); cows milk protein intolerance (3), gluten intolerance (3); miscellaneous (5); and undiagnosed enteropathy (9). Three of the EPEC showed localized pattern of adherence in vitro with HEP-2 cells. Most patients with salmonella and EPEC had severe secretory diarrhea with large fecal sodium losses. All 6 patients who died had secretory diarrhea and very high fecal sodium. All but 4 patients could be effectively managed with a chicken puree-glucose-coconut oil based diet.
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TI- The Contribution of Some Constitutional Factors (Genetic) to the Development of Cows Milk and Gluten Intolerance in Children. AU- Kaczmarski M; Kurzatkowska B CS- Department of Childrens Infectious Diseases, Medical Academy in BiaLystok, Poland. JN- Rocz Akad Med Bialymst; 33-34 p167-76 PY- 89 1988 AB- The role of genetic factors in the development of cows milk and gluten intolerance among hospitalized children was the subject of analysis made by the authors. The patients were hospitalized at the Clinic of Infectious Diseases of Children during 1973-1982. The first group consisted of 45 children whose ages ranged from 5 months to 5 years (gluten intolerance group), and the second group consisted of 50 children whose ages ranged from 2 months to 5 years (cows milk intolerance group). The study found that symptoms of the trait appeared in 34% of the family members of the children with milk intolerance, and 4.4% of the family members of the children with gluten intolerance. Coeliac disease was observed in 13.3% of the family members of the gluten intolerance group, and 10.8% psychic and/or diabetes disease was found in the same group. The data suggests that the illnesses discussed occur more frequently in members of the same family compared to control groups. This finding can speak for the participation of genetic factors in the development of these types of intolerance among family members. Study: Factors of Cows Milk and Gluten Intolerance* Symptom Group Family Members w/ Same Symptoms Family Members w/ Psychic and/or Diabetes Disease Family Members w/ Celiac Disease 45 Children w/ Gluten Intolerance 4.4% 10.8% 13.3% 50 Children w/ Cows Milk Intolerance 34% N/A N/A
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